Acute Suppurative Otitis Media

Acute inflammation of middle ear by pyogenic organisms

Aetiology

Infants and children of lower socioeconomic group

Follows viral infection of upper respiratory tract

Routes of Infection

Via eustachian tube

Via external ear

Blood borne

Predisposing Factors

Recurrent attacks of common cold, upper respiratory tract infections, exanthematous fevers

Infections of tonsils or adenoids

Chronic rhinitis and sinusitis

Nasal allergy

Tumours of nasopharynx, packing of nose, epistaxis

Cleft palate

Bacteriology

Streptococcus pneumoniae

Haemophilus influenzae

Moraxella catarrhalis

Streptococcus pyogenes

Staphylococcus aureus

Pseudomonas aeruginosa

Pathology and Clinical Features

Stage Pathology Symptoms Signs

Tubal Occlusion

• Oedema & hyperaemia of nasopharyngeal end of tube

• Retraction of TM

• Deafness• Earache

• TM retracted• Handle of

maleus more horizontal

• Lateral process of maleus prominent

• Loss of light reflex

• Conductive deafness

Stage Pathology Symptoms Signs

Presuppuration

• Pyogenic organsims invade tympanic cavity

• Hyperaemia of lining

• Inflammatory exudate in middle ear

• TM congested

• Earache o Throbbingo Disturbs

sleep

• Adults – deafness & tinnitus

• Children – Fever

• Congestion of pars tensa

• Cartwheel appearance of TM

• Conductive deafness

Suppuration • Pus in middle ear

• TM bulges out

• Severe earache

• Deafness increases

• Fevero Vomitingo Convulsions

• TM o Redo Bulgingo Loss of

landmarks• Tenderness

over mastoid antrum

Stage Pathology Symtoms Signs

Resolution • TM ruptures• Release of

pus• Subsidence

of symptoms

• Earache relieved

• Fever subsides

• EAC may contain blood-tinged discharge

• Later becomes mucopurulent

Complication • Virulence of organism is high

• Resistance of host is poor

• Acute mastoiditis• Labyrinthitis• Subperiosteal abscess• Facial paralysis• Petrositis• Extradural abscess• Meningitis• Brain abscess• Lateral sinus

thrombophlebitis

Treatment

Antibacterial therapy Ampicillin 50mg/kg/day in 4 divided

doses Amoxicillin 40mg/kg/day in 3 divided

doses

Decongestant nasal drops Ephedrine (1% in adults & 0.5% in

children) Oxymetazoline Xylometazoline

Oral nasal decongestants Pseudoephedrine 30mg twice daily

Analgesics & antipyretics Paracetamol

Ear toilet Dry-mopping

Dry local heat Relieves pain

Myringotomy Drum is bulging; acute pain Incomplete resolution despite antibiotics; persistent conductive

deafness Persistent effusion beyond 12 weeks

Acute Necrotising Otitis Media

Variety of ASOM seen in children suffering from exanthematous fevers

Caused by B-haemolyticus streptococci

Rapid destruction of entire tympanic membrane

Profuse otorrhea

Healing followed by fibrosis or secondary acquired cholesteatoma

Treatment Antibacterial therapy for a least 7-10

days Cortical mastoidectomy

Medical treatment fails to control Condition gets complicated by

acute mastoiditis

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